A Review of the Opioid Epidemic: What Do We Do About It?

Abstract

The opioid epidemic, with its noticeable increase in opioid prescriptions and related misuse, abuse and resultant deaths in the previous 12 years, is a particularly North American phenomenon. Europe, and particularly low- and middle-income countries, appear to be less influenced by this problem. There is undisputable value in using opioids not only in the treatment of acute pain, but in cancer pain as well. However, opioids are progressively being prescribed more and more for chronic non-cancer pain, despite inadequate data on their efficacy. In this paper, we describe the current prevalence of opioid misuse in a number of countries and the rationale for the commencement of opioid therapy. The safe initiation and monitoring of opioid therapy as well as the need for concurrent use of interdisciplinary multimodal therapy is discussed. The possible consequences of long-term use and predictors of high opioid use and overdose are presented. In particular, the management of opioid use disorders and the prevention of opioid abuse and dependence in the young, the old and the pregnant are discussed. Measures to prevent overprescribing and to alleviate risk are described, including the tapering of opioids and the use of opioid deterrents. Finally, the paper looks at the future development of pioneering medications and technologies to potentially treat abuse. In those parts of the world with an opioid epidemic, coroners and medical examiners, private and public health agencies, and agencies that enforce the law need to cooperate in an effort to slow down and reverse the indiscriminate use of prescribing opioids in the long-term for chronic non-cancer pain. Ongoing research is needed to create ways to minimise risks of opioid use, and to provide evidence for effective strategies for treating chronic pain.

Trends in the consumption of opioids for the treatment of severe pain in Europe, 1990–2016

“…Opioid use has also been increasing in other areas in the world, including a few European countries, Australia and New Zealand which, together with the United States, account for about 90% of total consumption of fentanyl, oxycodone and morphine worldwide (Berterame et al, 2016;Hastie et al, 2014;Shipton, Shipton, & Shipton, 2018). However, in many other countries, especially those in low-income areas, the use of opioids remains inadequate (Duthey & Scholten, 2014;Seya, Gelders, Achara, Milani, & Scholten, 2011).…”

Prescription Opioid Analgesic Use and Mortality in Systemic Lupus Erythematosus

“…Although certain guidelines recommended narcotic analgesics to manage recalcitrant chronic pain in osteoarthritis and rheumatoid arthritis, other guidelines minimized the use of opioids and recommended other non-opioid methods of pain control (25,26). However, opioid analgesic use has markedly increased among arthritis patients followed by numerous reports of adverse opioid effects on outcome in certain populations (8,9,10,(27)(28)(29)(30)(31)(32). show signs of pain-related dysfunction, including distress, activity interference, catastrophising, and interpersonal difficulties (2,3,(33)(34)(35).…”

“…The use of opioid analgesics in rheumatoid arthritis for chronic pain has been associated with increased serious adverse events including safety events, falls, fractures and increased allcause mortality (9,10). The increased mortality associated with opioid analgesics appears to be in part due to increased accidents and unobserved cardiopulmonary arrest (31, 32,36).…”

“…As recently reviewed by Borenstein et al and others, opioid analgesics are sometimes incorporated into pain management in order to relieve suffering, avoid acetaminophen and non-steroidal anti-inflammatory drug toxicity, preserve renal function, and reduce corticosteroid use (6)(7)(8). However, routine opioid analgesic use for chronic pain can result in dangerous opioid abuse and dependence as recently reviewed by Shipton et al (9). Although there has been important research into the effects of opioid analgesics on the outcomes chronic arthritis as recently reported by lociganic et al and others, the literature for epidemiology of opioid-based chronic pain management in SLE is limited (10,11).…”

Present and Future Pharmacological Treatments for Opioid Addiction

“…In order to restructure these memories and avoid relapse and craving to opioids, the first recommended approach currently consists in combining psychotherapy with pharmacological substitution therapy [3]. Opioid addiction is currently a major medical and social problem, and its abuse and recreational use have been declared an epidemic in the USA [4,5], with more than 90 people dying from an opioid overdose every day [6].…”